Table of ContentsView AllTable of ContentsH2 Blockers vs PPI: How They WorkEffectivenessHow Long Do They Take To Work?Indications and UsageSide Effects and SafetyHow to ChooseLifestyle Modifications and Alternative Treatments
Table of ContentsView All
View All
Table of Contents
H2 Blockers vs PPI: How They Work
Effectiveness
How Long Do They Take To Work?
Indications and Usage
Side Effects and Safety
How to Choose
Lifestyle Modifications and Alternative Treatments
Acid reflux(gastroesophageal reflux) occurs when stomach contents enter youresophagus.
Up to one in five adults in the U.S. experience symptoms of acid reflux at least once a week.Thesesymptomscan include the following:
Medications are often necessary to manage discomfort and prevent complications of acid reflux, such as:
Prilosec OTC is pictured in a Cambridge, Massachusetts Pharmacy.Bloomberg / Contributor / Getty Images
Bloomberg / Contributor / Getty Images
Bothhistamine-2 receptor antagonists(H2 blockers) and proton pump inhibitors (PPIs) decrease stomach acid but work differently.
H2 blockers reduce the production of stomach acid through a histamine receptor blockade.
Medications in this class include the following:
In contrast to H2 blockers,PPIsdirectly block the proton pump responsible for producing stomach acid.For best results, take PPIs 30 to 60 minutes before your meal.
H2 Blockers vs. PPI Effectiveness
PPIs are the most effective medicines for acid reflux across the board.They relieve heartburn in up to 77% of people withesophagitis(inflammation of the esophagus) and 60% without esophagitis.They are even more effective in healing the esophagus and work in about 80% of esophagitis cases.
H2 blockers are less effective at treating reflux symptoms than PPIs. H2 blockers relieve heartburn in about 50% of people who take them for up to 12 weeks.They heal esophagitis in about 40% of people who take them.
A Word From VerywellWhen choosing between a PPI or an H2 blocker, the decision depends on your symptoms. If you experience two or fewer GERD episodes per week and have not been diagnosed with esophagitis, H2 blockers should be your first choice. On the other hand, if you have severe or frequent GERD symptoms, erosive esophagitis, or Barrett’s esophagus, then a PPI is the way to go.—FEMI AREMU, PHARMD, MEDICAL EXPERT BOARD
A Word From Verywell
When choosing between a PPI or an H2 blocker, the decision depends on your symptoms. If you experience two or fewer GERD episodes per week and have not been diagnosed with esophagitis, H2 blockers should be your first choice. On the other hand, if you have severe or frequent GERD symptoms, erosive esophagitis, or Barrett’s esophagus, then a PPI is the way to go.—FEMI AREMU, PHARMD, MEDICAL EXPERT BOARD
When choosing between a PPI or an H2 blocker, the decision depends on your symptoms. If you experience two or fewer GERD episodes per week and have not been diagnosed with esophagitis, H2 blockers should be your first choice. On the other hand, if you have severe or frequent GERD symptoms, erosive esophagitis, or Barrett’s esophagus, then a PPI is the way to go.
—FEMI AREMU, PHARMD, MEDICAL EXPERT BOARD
How Long Do H2 Blockers vs. PPI Take to Work?
H2 blockers start working faster than PPIs, typically within one to three hours. In contrast, it may take up to four days to see the effects of PPIs.
The effects of PPIs last longer than those of H2 blockers. PPIs block stomach acid 15 to 21 hours a day versus about eight hours for H2 blockers.
PPIs are recommended for most cases of acid reflux. They are broadly used for conditions like the following:
However, there are some situations in which H2 blockers are typically recommended instead. Some of these include the following:
Taking prescription or over-the-counter (OTC) H2 blockers or PPIs may cause side effects and drug interactions. Some precautions for certain groups are also important to note.
Side Effects
The side effects of these two drug classes are similar, primarily affecting the gastrointestinal tract.
Common side effects of H2 blockers include the following:
More serious side effects of these medicines include the following:
Tolerance(tachyphylaxis) to H2 blockers can develop within as little as three days.This means the medicine doesn’t work as well after the body gets used to it, and higher doses may be necessary to get the same results.
PPIs can cause the followingside effects:
Long-term use of PPIs is associated with some significant risks, which include the following:
Deciding how long to use PPIs can be a tricky situation. Drug manufacturers recommend taking PPIs for less than eight weeks to reduce the risk of side effects.However, many people who use PPIs for GERD will stay on them indefinitely (lifelong) because stopping treatment often causes reflux symptoms to return.
Be sure to discuss the risks and benefits of prolonged PPI therapy with your healthcare provider for optimal safety.
Precautions
Keep in mind these precautions for the following groups:
Interactions
H2 blockers and PPIs can cause some significant drug interactions. Here are a few important ones to keep in mind:
Recall InformationIn 2020, the H2 blocker Zantac (ranitidine) was pulled from the market due to the presence ofN‐nitrosodimethylamine (NDMA). NDMA is thought to be a carcinogen (cancer-causing agent).The U.S. Food and Drug Administration (FDA) determined that levels of NDMA found in ranitidine could increase if stored at high temperatures.Keep in mind that the product Zantac 360 that’s currently available contains famotidine, not ranitidine.
Recall Information
In 2020, the H2 blocker Zantac (ranitidine) was pulled from the market due to the presence ofN‐nitrosodimethylamine (NDMA). NDMA is thought to be a carcinogen (cancer-causing agent).The U.S. Food and Drug Administration (FDA) determined that levels of NDMA found in ranitidine could increase if stored at high temperatures.Keep in mind that the product Zantac 360 that’s currently available contains famotidine, not ranitidine.
In 2020, the H2 blocker Zantac (ranitidine) was pulled from the market due to the presence ofN‐nitrosodimethylamine (NDMA). NDMA is thought to be a carcinogen (cancer-causing agent).
The U.S. Food and Drug Administration (FDA) determined that levels of NDMA found in ranitidine could increase if stored at high temperatures.
Keep in mind that the product Zantac 360 that’s currently available contains famotidine, not ranitidine.
The choice of which medicine to take for acid reflux may come down to factors such as the following:
Consult your healthcare professional or pharmacist for personalized evaluation and treatment recommendations.
Lifestyle modifications, alone or in conjunction with medications, can help control symptoms of acid reflux.
Some recommended strategies include the following:
Additionally, supplements that may help with acid reflux symptoms include the following:
More research is necessary before these can be routinely recommended.
Remember that the FDA doesn’t approve supplements before products are marketed like they do for prescription medications. This means they don’t have to be proven safe or effective. Check outtips for choosing a supplement.
Summary
PPIs and H2 blockers are the most commonly taken medications to treat acid reflux and its complications, including GERD and esophagitis.
In many cases, PPIs are recommended first because they are more effective than H2 blockers at reducing stomach acid and symptoms like heartburn. Though the side effects of these two classes are similar, the prolonged use of PPIs is associated with severe adverse effects like fractures, infections, and even dementia.
If you are experiencing acid reflux, discuss treatment options with your healthcare provider to help you achieve your health goals.
17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Clarrett DM, Hachem C.Gastroesophageal reflux disease (GERD).Mo Med. 2018;115(3):214-218.Gelardi M, Ciprandi G.Focus on gastroesophageal reflux (GER) and laryngopharyngeal reflux (LPR): new pragmatic insights in clinical practice.J Biol Regul Homeost Agents. 2018;32(1 Suppl. 2):41-47.National Institute of Diabetes and Digestive and Kidney Diseases.Histamine type-2 receptor antagonists (H2 blockers). In:LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): January 25, 2018.Strand DS, Kim D, Peura DA.25 years of proton pump inhibitors: a comprehensive review.Gut Liver. 2017;11(1):27-37. doi:10.5009/gnl15502Liang SW, Wong MW, Yi CH, et al.Current advances in the diagnosis and management of gastroesophageal reflux disease.Tzu Chi Med J. 2022;34(4):402-408. Published 2022 May 16. doi:10.4103/tcmj.tcmj_323_21Vordenberg SE.Nonprescription heartburn medications for adults.JAMA. 2023;330(15):1499-1499. doi:10.1001/jama.2023.16280Shim YK, Kim N.The effect of H2 receptor antagonist in acid inhibition and its clinical efficacy.Korean J Gastroenterol. 2017;70(1):4-12. doi:10.4166/kjg.2017.70.1.4Shin JM, Sachs G.Pharmacology of proton pump inhibitors.Curr Gastroenterol Rep. 2008;10(6):528-534. doi:10.1007/s11894-008-0098-4Altuwaijri M.Evidence-based treatment recommendations for gastroesophageal reflux disease during pregnancy: a review.Medicine (Baltimore). 2022;101(35):e30487. doi:10.1097/MD.0000000000030487Leung AK, Hon KL.Gastroesophageal reflux in children: an updated review.Drugs Context. 2019;8:212591. Published 2019 Jun 17. doi:10.7573/dic.212591American College of Gastroenterology.Acid reflux/GERD (gastroesophageal reflux disease).U.S. Food and Drug Administration.Prilosec (omeprazole) prescribing information.Lehault WB, Hughes DM.Review of the long-term effects of proton pump inhibitors.Fed Pract. 2017;34(2):19-23.Northuis CA, Bell EJ, Lutsey PL, et al.Cumulative use of proton pump inhibitors and risk of dementia: the atherosclerosis risk in communities study.Neurology. 2023;101(18):e1771-e1778. doi:10.1212/WNL.0000000000207747Koyyada A.Long-term use of proton pump inhibitors as a risk factor for various adverse manifestations.Therapie. 2021;76(1):13-21. doi:10.1016/j.therap.2020.06.019Wagner JA, Dinh JC, Lightdale JR, et al.Is this the end for ranitidine? NDMA presence continues to confound.Clin Transl Sci. 2021;14(4):1197-1200. doi:10.1111/cts.12995Schulz RM, Ahuja NK, Slavin JL.Effectiveness of nutritional ingredients on upper gastrointestinal conditions and symptoms: a narrative review.Nutrients. 2022;14(3):672. Published 2022 Feb 5. doi:10.3390/nu14030672
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Clarrett DM, Hachem C.Gastroesophageal reflux disease (GERD).Mo Med. 2018;115(3):214-218.Gelardi M, Ciprandi G.Focus on gastroesophageal reflux (GER) and laryngopharyngeal reflux (LPR): new pragmatic insights in clinical practice.J Biol Regul Homeost Agents. 2018;32(1 Suppl. 2):41-47.National Institute of Diabetes and Digestive and Kidney Diseases.Histamine type-2 receptor antagonists (H2 blockers). In:LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): January 25, 2018.Strand DS, Kim D, Peura DA.25 years of proton pump inhibitors: a comprehensive review.Gut Liver. 2017;11(1):27-37. doi:10.5009/gnl15502Liang SW, Wong MW, Yi CH, et al.Current advances in the diagnosis and management of gastroesophageal reflux disease.Tzu Chi Med J. 2022;34(4):402-408. Published 2022 May 16. doi:10.4103/tcmj.tcmj_323_21Vordenberg SE.Nonprescription heartburn medications for adults.JAMA. 2023;330(15):1499-1499. doi:10.1001/jama.2023.16280Shim YK, Kim N.The effect of H2 receptor antagonist in acid inhibition and its clinical efficacy.Korean J Gastroenterol. 2017;70(1):4-12. doi:10.4166/kjg.2017.70.1.4Shin JM, Sachs G.Pharmacology of proton pump inhibitors.Curr Gastroenterol Rep. 2008;10(6):528-534. doi:10.1007/s11894-008-0098-4Altuwaijri M.Evidence-based treatment recommendations for gastroesophageal reflux disease during pregnancy: a review.Medicine (Baltimore). 2022;101(35):e30487. doi:10.1097/MD.0000000000030487Leung AK, Hon KL.Gastroesophageal reflux in children: an updated review.Drugs Context. 2019;8:212591. Published 2019 Jun 17. doi:10.7573/dic.212591American College of Gastroenterology.Acid reflux/GERD (gastroesophageal reflux disease).U.S. Food and Drug Administration.Prilosec (omeprazole) prescribing information.Lehault WB, Hughes DM.Review of the long-term effects of proton pump inhibitors.Fed Pract. 2017;34(2):19-23.Northuis CA, Bell EJ, Lutsey PL, et al.Cumulative use of proton pump inhibitors and risk of dementia: the atherosclerosis risk in communities study.Neurology. 2023;101(18):e1771-e1778. doi:10.1212/WNL.0000000000207747Koyyada A.Long-term use of proton pump inhibitors as a risk factor for various adverse manifestations.Therapie. 2021;76(1):13-21. doi:10.1016/j.therap.2020.06.019Wagner JA, Dinh JC, Lightdale JR, et al.Is this the end for ranitidine? NDMA presence continues to confound.Clin Transl Sci. 2021;14(4):1197-1200. doi:10.1111/cts.12995Schulz RM, Ahuja NK, Slavin JL.Effectiveness of nutritional ingredients on upper gastrointestinal conditions and symptoms: a narrative review.Nutrients. 2022;14(3):672. Published 2022 Feb 5. doi:10.3390/nu14030672
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Clarrett DM, Hachem C.Gastroesophageal reflux disease (GERD).Mo Med. 2018;115(3):214-218.Gelardi M, Ciprandi G.Focus on gastroesophageal reflux (GER) and laryngopharyngeal reflux (LPR): new pragmatic insights in clinical practice.J Biol Regul Homeost Agents. 2018;32(1 Suppl. 2):41-47.National Institute of Diabetes and Digestive and Kidney Diseases.Histamine type-2 receptor antagonists (H2 blockers). In:LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): January 25, 2018.Strand DS, Kim D, Peura DA.25 years of proton pump inhibitors: a comprehensive review.Gut Liver. 2017;11(1):27-37. doi:10.5009/gnl15502Liang SW, Wong MW, Yi CH, et al.Current advances in the diagnosis and management of gastroesophageal reflux disease.Tzu Chi Med J. 2022;34(4):402-408. Published 2022 May 16. doi:10.4103/tcmj.tcmj_323_21Vordenberg SE.Nonprescription heartburn medications for adults.JAMA. 2023;330(15):1499-1499. doi:10.1001/jama.2023.16280Shim YK, Kim N.The effect of H2 receptor antagonist in acid inhibition and its clinical efficacy.Korean J Gastroenterol. 2017;70(1):4-12. doi:10.4166/kjg.2017.70.1.4Shin JM, Sachs G.Pharmacology of proton pump inhibitors.Curr Gastroenterol Rep. 2008;10(6):528-534. doi:10.1007/s11894-008-0098-4Altuwaijri M.Evidence-based treatment recommendations for gastroesophageal reflux disease during pregnancy: a review.Medicine (Baltimore). 2022;101(35):e30487. doi:10.1097/MD.0000000000030487Leung AK, Hon KL.Gastroesophageal reflux in children: an updated review.Drugs Context. 2019;8:212591. Published 2019 Jun 17. doi:10.7573/dic.212591American College of Gastroenterology.Acid reflux/GERD (gastroesophageal reflux disease).U.S. Food and Drug Administration.Prilosec (omeprazole) prescribing information.Lehault WB, Hughes DM.Review of the long-term effects of proton pump inhibitors.Fed Pract. 2017;34(2):19-23.Northuis CA, Bell EJ, Lutsey PL, et al.Cumulative use of proton pump inhibitors and risk of dementia: the atherosclerosis risk in communities study.Neurology. 2023;101(18):e1771-e1778. doi:10.1212/WNL.0000000000207747Koyyada A.Long-term use of proton pump inhibitors as a risk factor for various adverse manifestations.Therapie. 2021;76(1):13-21. doi:10.1016/j.therap.2020.06.019Wagner JA, Dinh JC, Lightdale JR, et al.Is this the end for ranitidine? NDMA presence continues to confound.Clin Transl Sci. 2021;14(4):1197-1200. doi:10.1111/cts.12995Schulz RM, Ahuja NK, Slavin JL.Effectiveness of nutritional ingredients on upper gastrointestinal conditions and symptoms: a narrative review.Nutrients. 2022;14(3):672. Published 2022 Feb 5. doi:10.3390/nu14030672
Clarrett DM, Hachem C.Gastroesophageal reflux disease (GERD).Mo Med. 2018;115(3):214-218.
Gelardi M, Ciprandi G.Focus on gastroesophageal reflux (GER) and laryngopharyngeal reflux (LPR): new pragmatic insights in clinical practice.J Biol Regul Homeost Agents. 2018;32(1 Suppl. 2):41-47.
National Institute of Diabetes and Digestive and Kidney Diseases.Histamine type-2 receptor antagonists (H2 blockers). In:LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): January 25, 2018.
Strand DS, Kim D, Peura DA.25 years of proton pump inhibitors: a comprehensive review.Gut Liver. 2017;11(1):27-37. doi:10.5009/gnl15502
Liang SW, Wong MW, Yi CH, et al.Current advances in the diagnosis and management of gastroesophageal reflux disease.Tzu Chi Med J. 2022;34(4):402-408. Published 2022 May 16. doi:10.4103/tcmj.tcmj_323_21
Vordenberg SE.Nonprescription heartburn medications for adults.JAMA. 2023;330(15):1499-1499. doi:10.1001/jama.2023.16280
Shim YK, Kim N.The effect of H2 receptor antagonist in acid inhibition and its clinical efficacy.Korean J Gastroenterol. 2017;70(1):4-12. doi:10.4166/kjg.2017.70.1.4
Shin JM, Sachs G.Pharmacology of proton pump inhibitors.Curr Gastroenterol Rep. 2008;10(6):528-534. doi:10.1007/s11894-008-0098-4
Altuwaijri M.Evidence-based treatment recommendations for gastroesophageal reflux disease during pregnancy: a review.Medicine (Baltimore). 2022;101(35):e30487. doi:10.1097/MD.0000000000030487
Leung AK, Hon KL.Gastroesophageal reflux in children: an updated review.Drugs Context. 2019;8:212591. Published 2019 Jun 17. doi:10.7573/dic.212591
American College of Gastroenterology.Acid reflux/GERD (gastroesophageal reflux disease).
U.S. Food and Drug Administration.Prilosec (omeprazole) prescribing information.
Lehault WB, Hughes DM.Review of the long-term effects of proton pump inhibitors.Fed Pract. 2017;34(2):19-23.
Northuis CA, Bell EJ, Lutsey PL, et al.Cumulative use of proton pump inhibitors and risk of dementia: the atherosclerosis risk in communities study.Neurology. 2023;101(18):e1771-e1778. doi:10.1212/WNL.0000000000207747
Koyyada A.Long-term use of proton pump inhibitors as a risk factor for various adverse manifestations.Therapie. 2021;76(1):13-21. doi:10.1016/j.therap.2020.06.019
Wagner JA, Dinh JC, Lightdale JR, et al.Is this the end for ranitidine? NDMA presence continues to confound.Clin Transl Sci. 2021;14(4):1197-1200. doi:10.1111/cts.12995
Schulz RM, Ahuja NK, Slavin JL.Effectiveness of nutritional ingredients on upper gastrointestinal conditions and symptoms: a narrative review.Nutrients. 2022;14(3):672. Published 2022 Feb 5. doi:10.3390/nu14030672
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